Medicare in “chronic” condition; fiscally in “acute care”

The health of the Medicare monopoly “isn’t very good,” Dr. Bob Hollinshead, chair of Canadians for Sustainable Medicare [C4SM] told the Alberta Medical Association’s Representative Forum this morning [March 11]. “In fact, it is appalling bad.”

Like many patients “who are in their mid-50s, the Medicare monopoly has a number of chronic conditions” such as:

  • “Lack of timely access to quality care.
  • “Rationing.
  • “No choice for patients when Medicare fails to deliver on its promises.
  • “Stasis throughout the whole system.”

“Let be absolutely clear,” Dr. Hollinshead said: “Canadians for Sustainable Medicare does NOT want to get rid of publicly funded health care.”

However, its increasing costs are not sustainable and leave less and less money “for other services that Albertans expect and deserve.” For example, affordable housing, programs for seniors, support for low-income Albertans and education.”

Medicare “prohibits choice but it does not offer any guarantees as to service, access and quality,” said Dr. Hollinshead. On the other hand, “governments have no hesitation in holding the private sector accountable for performance standards.”

Dr. Hollinshead’s speaking notes are reprinted below:

Speaking Notes

Dr. Bob Hollinshead

Chair, Board of Directors

Canadians for Sustainable Medicare


Alberta Medical Association

Representative Forum

Edmonton, March 11, 2016

[Check Against Delivery]

Good morning.

It’s wonderful to be back at RF … and thank you for the invitation.

I welcome the opportunity to introduce Canadians for Sustainable Medicare to the leadership of the AMA.

Our goal is to change the framework for health care in the future.

My dream for the future is that all Albertans will receive the same timely access that injured WCB workers, RCMP officers and professional athletes receive today.Yes, we may be a tad ambitious … but then Bill Gates and Steven Jobs weren’t satisfied with simply building a better typewriter.

We all know the publicly funded health care systems in the provinces and the territories are important to Canadians.

We know that the Federal Government’s financial contributions to Medicare are very important for its sustainability.

So, let me be absolutely clear – Canadians for Sustainable Medicare does NOT want to get rid of publicly funded health care.

But when we look at Medicare in 2016, its health isn’t very good. In fact, it is appallingly bad.

Like some of our patients who are in their mid-50s, the Medicare monopoly has a number of chronic conditions.

For example:

  1. Lack of timely access to quality care.
  2. No choice for patients when Medicare fails to deliver on its promises.
  3. Stasis throughout the whole system.

Medicare is also in the financial ICU. Here is the fiscal diagnosis … and why it puts Medicare in the category of needing acute care.

  • 35 years ago in Alberta… in the early 1980s, when I was a young orthopod starting out … Medicare consumed 30 cents of every dollar in the government’s operating budget.
  • Today, it is close to 50 cents.
  • And, if the trend continues, in another 30 years … around 2045 … the Medicare monopoly will be eating 70 cents of every taxpayer dollar.

This won’t leave much money for the many other services that Albertans expect and deserve.

It won’t leave the Alberta Government much money to address other determinants of health such as:

  1. Affordable housing
  2. Programs for seniors
  3. Support for low-income Albertans
  4. Education

The situation isn’t much better in the other provinces … and indeed, may be worse. For example, reports put the number of Ontario residents annually seeking health care in the United States at between 17,000 and 30,000.

It is so disappointing that many politicians refuse to accept the diagnosis that Medicare is unsustainable. And, even those who do … are too timid to do, or to say, anything about it.

Medicare is a government monopoly … and it’s a heavily unionized monopoly. This explains why groups such as Friends of Medicare and Public Interest Alberta in this province:

  1. Oppose private funding for hospital and physician services.
  1. Oppose private delivery of hospital and physician services.
  1. Oppose choice for patients to seek care elsewhere … in Canada … when Medicare fails to deliver on its promise of timely access to quality care.

Tommy Douglas … the former Premier of Saskatchewan and “the father of Canadian Medicare” was fiscally sensible and financially responsible.

It is reported that he delayed bringing in Medicare until he thought Saskatchewan could afford it.

His supporters … through the decades … have been silent on it being fiscally sensible, financially responsible … and affordable.

But, they have been vociferous in defining a singular view of:

  • What Medicare “is” … and also a singular view of
  • What Medicare “can ONLY be.”

People like Professor Flood deserve credit for how they have succeeded in framing the notion that Medicare defines us as a nation. They have done one heck of a job.

There are, however, many Albertans and many Canadians who disagree that Medicare should be a public monopoly.

I am one of them. Others are sitting in this room.

Canada is the only country in the world to outlaw private insurance for health care that is felt to be “medically necessary.”

Among the 34 member countries of the OECD, Canada spends 36% more per capita than the OECD average… yet achieves mediocre deliverables in many areas.

For example, Canada has the longest wait times for elective surgery … and is near the bottom – at 29th or 30th – in the number of acute care beds per 1,000 population.

The Canadian health care system delivers outstanding urgent and emergent care to Canadians, but Medicare has failed many of our patients awaiting scheduled or elective access to care.

Rather than look to the United States for a system to emulate, we should look to learn from countries like the Netherlands and Germany where just 5% of their citizens waited more than 4 months for surgical treatment.

My family medicine colleagues across Canada can attest to the waiting lists for many specialist services that grow longer every year.

My orthopedic colleagues in Calgary tell me it is not unusual for a patient to wait a year or longer to see a consultant …and to receive care … for conditions such as a rotator cuff tear, torn knee cartilage, or disc protrusion.

Numerous commissions, government studies and think tank reports have reached the same conclusion – patients and taxpayers can’t afford what Medicare has become … and what the future holds if nothing changes.

Medicare prohibits choice but it does not offer any guarantees as to service, access and quality.

Governments have no hesitation in holding the private sector accountable for performance standards … but they refuse to “walk the talk” when it comes to Medicare.

Health care professionals on the front lines are tired of politicians and government bureaucracies telling us how we can best serve our patients … while they go about restructuring Alberta Health Services every few years.

But, this attitude is not new.

Does this sound familiar? [And, I quote]

“We trained hard, but it seemed that every time we were beginning to form up into teams, we would be reorganized.

“I was to learn later in life that we tend to meet any new situation by reorganizing; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralization.”

This was written in 210 BC by a fellow by the name of Gaius Petronius.

I will conclude by briefly touching on:

  • Two Supreme Court of Canada decisions that may enhance patient choice in the future.
  • Brian Day’s case against the BC Government.
  • My decision to opt out of the Alberta Health Care Insurance Plan.

First, the decisions by the Supreme Court of Canada.

Decision #1

The pro-Medicare, pro-monopoly crowd was aghast at the court’s decision in 2005 with its Chaoulli decision … when the Supreme Court of Canada ruled that access to a wait list is not access to care.

The Canadian Medical Association and the Canadian Orthopaedic Association had status as co-interveners in that case.

I had the privilege to be in court along with the CMA president as the COA and the CMA argued for a wait time guarantee if wait-time benchmarks were exceeded.

The wait-time guarantee would provide Canadians with an option to the Medicare monopoly.

Unfortunately that decision was applicable only in Quebec and not the other common law provinces.

Decision #2

The Supreme Court’s second decision involves a person’s right-to-die, and the court’s directive to the Government of Canada to put appropriate legislation into place.

It’s all about patient choice.

But, it seems to me that if a person can make the decision to die with our help – then they should also be able to make the decision to receive care from the private sector here, in Canada, so that they can live.

Dr. Brian Day

To use the political catchphrase of the day, “just to be transparent” … I am an expert witness for the plaintiffs against the Government.

Patients are also involved in the case supporting Dr. Day. In a nutshell, it involves a person’s right to purchase health care privately here in Canada.

After two postponements … both requested by the BC Government … legal proceedings will finally move ahead this June in the Supreme Court of British.

The second postponement occurred last fall when … just hours before the court was to sit … the Government of British Columbia “discovered” 300,000 documents of which it had not been aware.

You heard me right: “the Government of British Columbia discovered 300,000 documents of which it had not been aware.” As a result, the BC government has been handing over 30,000 documents a month to Dr. Day’s legal team.

The Supreme Court judge admonished the Government and told it that there will be no more delays.

FINALLY – Opting Out

Which brings me to opting out. Why did I do it?

Well, by now you have a pretty good idea. I devoted 35 years of my professional life to publicly funded health care. I think it was a win-win.

But, let me give two more reasons for opting out.

  1. My leaving the public system opened up OR space for a young, well-trained and deserving orthopedic surgeon. Presently in orthopaedics there are 153 new and well-trained surgeons looking for a job in our publicly funded system.
  1. Now … as an opted-out physician … I am helping ordinary Albertans to get back to work much, much sooner. Some are truck drivers, some are carpenters, and some are city employees.

This has huge implications – for the patient’s mental and physical well-being … for their family’s financial well-being … for the patient’s self-esteem … and for our economy.

The Alberta Medical Association has trademarked “Patients First.”

Canadians for Sustainable Medicare totally agrees.

  • It is time to put Patients First … and not a Medicare monopoly conceived in the middle of the 20th
  • It is time that Albertans and Canadians had choices to receive their health care North of the 49th
  • It is time to make Medicare sustainable.
  • It is time to make Medicare accountable.
  • It is time to value the innovation and contributions that the private sector can bring.
  • It is time to reframe the future of health care in this great province and in this great country.

The resolution before you today calls on you … the leadership of the Alberta Medical Association … to put “Patients First.”

You can help move Medicare into the 21st century.

In the words of Tommy Douglas’ most famous quote – “Courage my friends; ‘tis not too late to make a better world.”

In closing, I would encourage you to check our website … Canadians for Sustainable Medicare … and to support us in whatever way you can.

Thank You.







Canada’s government-run health care system – Medicare -- is a monopoly that prohibits private hospital and private physician care. Medicare is a subpar performer, ranking 10th among 11 advanced countries. Canadians deserve much better! Patients deserve timely access to quality care and choice of hospitals and physicians. Taxpayers deserve much more value for their tax dollars.

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